Referring Offices – KC Vision Performance

KC Vision Performance works with referring physicians and professionals to provide patients with comprehensive neuro-optometry, low vision, and vision therapy services.

We are grateful to those who take the time to refer for our special area of vision care. If you are a referring physician, your office staff is welcome to call our office at (913) 469-8686 to schedule an appointment when your patient is at your office. We will then follow up with the patient to prepare them to visit our office.

Printable Referral Forms

Download a PDF below and fax it to our office at (913) 469-8688.

E-mail Referral Form

Fields marked with an * are required

Type of vision care requested:

Patient First & Last Name *

Patient Phone Number *

Patient E-mail Address

Referring Doctor/Physician/Professional *

Referring Office Phone *

Please share any additional information:

triage

Please fax your patient's records to (913) 469-8688. We'll call if we need additional information and send a report back to you once we have treated your patient. We'll follow up by phone or e-mail to schedule your patient for an appointment and prepare them to visit our office. Thank you for referring!